Tan Virak, Nourbakhsh Ali, Capo John, Cottrell Jessica A, Meyenhofer Marcus, O'Connor J Patrick
Department of Biochemistry and Molecular Biology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School and Graduate School of Biomedical Sciences, Newark, NJ, USA.
J Hand Surg Am. 2010 Jun;35(6):941-7. doi: 10.1016/j.jhsa.2010.02.033.
Besides its anti-inflammatory effects, nonsteroidal anti-inflammatory drug therapy may affect tendon healing and the development of peritendinous adhesions. The purpose of this study was to compare the effect of nonselective (ibuprofen) and COX-2 selective (rofecoxib) nonsteroidal anti-inflammatory drugs on the adhesion formation after tendon repair.
We assigned 67 rabbits to one of 3 (placebo, ibuprofen, or rofecoxib) groups. The deep flexor tendon was transected, followed by a primary repair. Dosing of the medication began the day after surgery and continued for 27 days. The animals were immobilized in a cast for the first 14 days. Postoperatively, tendon adhesion formation was assessed histologically by calculating the total adhesion in serial axial tendon sections at 3 and 6 weeks and by range of motion measurements at 6 and 12 weeks. We measured range of motion by fixing the metacarpal, applying increasing weight to the free end of the flexor digitorum profundus, and measuring the flexion angle between the metacarpal and the proximal phalanx. Comparison was performed between the treatment groups, as well as to the unoperated forepaws.
Based on histology, we found no difference between the treatment groups when determining the percentage of adhesion between the flexor tendon and its sheath. Control unoperated forepaws had a significantly greater range of metacarpophalangeal joint flexion than the surgically repaired groups. At 12 weeks, range of motion in the ibuprofen group was significantly better than the placebo (p=.009) and rofecoxib (p=.009) groups.
Ibuprofen has a more important effect in limiting adhesion formation compared with rofecoxib after flexor tendon repair. Because ibuprofen inhibits both COX-1 and COX-2, whereas rofecoxib only inhibits COX-2, ibuprofen therapy appears to offer a greater beneficial effect on tendon repair by reducing formation of adhesions.
非甾体抗炎药疗法除了具有抗炎作用外，可能会影响肌腱愈合及腱周粘连的形成。本研究的目的是比较非选择性（布洛芬）和COX-2选择性（罗非昔布）非甾体抗炎药对肌腱修复后粘连形成的影响。
我们将67只兔子分为3组（安慰剂组、布洛芬组或罗非昔布组）中的一组。切断指深屈肌腱，然后进行一期修复。术后第一天开始给药，持续27天。最初14天将动物固定于石膏中。术后，通过计算3周和6周时连续轴向肌腱切片中的总粘连情况以及在6周和12周时测量活动度，从组织学上评估肌腱粘连形成情况。我们通过固定掌骨、在指深屈肌游离端施加逐渐增加的重量并测量掌骨与近节指骨之间的屈曲角度来测量活动度。对各治疗组之间以及与未手术的前爪进行比较。
基于组织学，在确定屈肌腱与其腱鞘之间的粘连百分比时，我们发现各治疗组之间没有差异。未手术的对照前爪掌指关节屈曲活动度明显大于手术修复组。在12周时，布洛芬组的活动度明显优于安慰剂组（p = 0.009）和罗非昔布组（p = 0.009）。
与罗非昔布相比，布洛芬在限制屈肌腱修复后粘连形成方面具有更重要的作用。由于布洛芬同时抑制COX-1和COX-2，而罗非昔布仅抑制COX-2，布洛芬疗法似乎通过减少粘连形成对肌腱修复具有更大的有益作用。
